{layout name="./base/base_back"}

		<link rel="stylesheet" type="text/css" href="/front/css/publishWish.css"/>
		<script src="/front/js/jquery.js" type="text/javascript"></script>
		<!--会员注册审核开始-->
		<div id="publish-wish-box">
			<div id="publish-wish">
				{include file="./navleft"}
				<div class="publish-wish-right">
					<div class="publish-wish-tit">联系人信息</div>
					<form action="/contactinfo" method="post">
						<div class="publish-wish-form">
							<div class="form-group-input">
								<label for="">姓名</label>
								<input type="text" name="name"  placeholder="请输入联系人姓名"/>
							</div>
							<div class="form-group-input">
								<label for="">手机号码</label>
								<input type="text" name="phone"  placeholder="请填写手机号码"/>
							</div>
							<div class="form-group-input">
								<label for="">邮箱</label>
								<input type="text" name="email" placeholder="请输入邮箱地址"/>
							</div>
							<div class="form-group-input">
								<label for="">证件类型</label>
								<select name="type">
									<option value="身份证">身份证</option>
									<option value="护照">护照</option>
								</select>
							</div>
							<div class="form-group-input">
								<label for="">证件号码</label>
								<input type="text" name="type_number" placeholder="请填写证件号码"/>
							</div>
							<div class="form-group-input">
								<button type="submit">提交</button>
							</div>
						</div>
					</form>
				</div>
			</div>
		</div>
		<!--会员注册审核结束-->
